Use of sexual health services

GPs can provide contraceptives (methods of preventing pregnancy). Some prefer getting contraception from their GPs because they've built a good relationship with their doctor over the years but sometimes people are put off because receptionists may seem nosey.

A couple - An Australian student who says that he learned a lot about sexual health from reading his older sister's magazines. He cannot understand how guys with no sisters cope or where they get their information from.

G' I've always been able to, I've always tried my GP first and have always been able to talk to her and get contraception or emergency contraception. But if I hadn't been able to I would have gone to a family planning clinic.

So your GP's a female?

G' Yeah.

And you have a good relationship?

G' Yeah.

Rapport with her?

G' Yeah.

So do you think that is one of the reasons why you go there?

G' Yeah. That's one reason, but I have also when she's not been there, I have seen other doctors in the practice who are male and I don't really have a problem talking to them about it either. I think I just phone my GP first because it's seems the easiest thing for me to do, It's quite near here.

view profile

Profile Info

Age at interview:

20

Sex:

Female

Background:

Bangladeshi woman who lives on her own. She left home at the age of fifteen and was in the care of social services. At the time of the interview she was a full-time student. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

Have you ever experienced any difficulty using your GP or any of the other services for sexual health?

No, I haven't you know. You know they usually ask you at the counter 'what is it for?' I just basically, I'm a very strong-minded person me yeah, I just tell 'em 'mind your own business'.

If I have some business to tell you, I'll tell you. I don't need to tell you I'm here to get a Depo injection done or I am here to get a pregnancy test done. If I am asking you that I wanna see a nurse its because there's an issue around it, like I need to see a nurse. Obviously I'm not gonna be stupid and go and see a nurse because I've got tonsillitis now am I?', and they just try and ask you to find out, it's always the Asian ones.

Its like 'can I ask you why you wanna see the nurse?' and I just think is it any of your business? I know my rights at the end of the day'

I know my rights because my GP explained the procedure to me. 'You don't have to tell anyone at the reception what you're here to see a nurse for' , so if I wanted to get a pregnancy test done 'what are you here to see the nurse for?' its my own business.

I don't wanna discuss it over the counter where there's like ten other staff and God knows how many patients behind me. 'I don't need to tell you', I know my rights. It doesn't bother me. But now when I go to get my Depo done I just say 'My Depo.' I am gonna be 21.

So it was good of the doctor to explain it to you?

So I was like hey, great, and she said to me 'No matter how close they are with your family, confidentiality is a big thing which we have to be discreet about at all times because if you're not you can lose your job".

Teenagers are often worried that their information may not be kept prviate (confidentiality) at their doctors and may be nervous, embarrassed or even scared the first time they approach family planning and sexual health services. If the receptionist seems unsympathetic it may put people off even more.

Recently graduated, works as a manual worker in a supermarket. As a gay man thinks that it is important to provide young people with a safe environment to learn about their sexuality.

Well, I feel very uncomfortable talking to my General Practitioner about this sort of thing, simply because my General Practitioner is a friend of my family and although he's s'posed to be you know, he's s'posed to be completely confidential etc. I've never felt particularly comfortable telling him. I mean I've, as I said before I've used the clinic, the STI clinic once when I felt specifically that I was might have been presenting myself at some risk.

I found it to be an unwelcoming experience and something that I definitely wouldn't have gone through with on my own, had I not had an adult there with me, I think I would have found it very traumatic. I wouldn't say I found the staff particularly helpful but there was a counsellor there who did discuss things with me and she was very friendly.

Why didn't you find them particularly helpful?

Well I mean not helpful, but they were very matter of fact which is fine, but I can imagine some people finding that incredibly difficult to deal with. Because of embarrassing and things like that and they were asking all these detailed questions etc, and to be fair if you got, if you've come to that situation, if you turned up at the clinic they shouldn't have to ask you all these questions. They should sort of, I think they should test you for everything and sort of give you advice, but not sort of...

They ask you detailed questions about your own sexual life?

Yes, which which for some people might put them off doing it again, you know. I think it's a situation which is, I think the one thing that majorly put me off was the fact that you have to book in advance where I was before, you have to make an appointment and when you turn up your appointment is not kept to the time, its after the appointment time and therefore you sit around for 3,4,5 hours waiting for it, which is enough to put you off doing it, I found that to be pretty bad where I was.

I also found that I missed one of my appointments in fact and although I was told that my details would be kept on file only for records. When I started receiving cards through the post saying I'm incredibly concerned that you didn't turn up for your appointment and things like that saying what my appointment was for, I felt that they crossed the line of patient confidentiality in the sense that someone else could have opened my mail.

I mean you can often have the situation when people have the same surname and the same first initial or something, and therefore someone else could have opened it and read the card or whatever.

view profile

Profile Info

Age at interview:

21

Sex:

Female

Background:

She was brought up in a rural area. Currently at University she has worked for several years as a peer educator for the sex education programme' A Pause.

So there is no question of difficulties or...?

With the Family Planning? Yes, I have in the past. I think it's really embarrassing when you know, particularly when I was younger, it's really embarrassing to have to go up to someone who's not medically trained on the reception whilst there is a queue behind you and other people and say 'Hi'. You know, I just want to be told 'off you go' and they ask you what you are in for, effectively, What do you want?

And I don't want to tell them with loads of people behind that I might possibly know. At the time it was really embarrassing and I think when I would have been younger I would have not gone, probably.

Yes, I mean and also I was aware, because I've taught sex education at that age, I was aware a lot that I, you know I found it okay and I got on with it and I did it, even though it was embarrassing. But someone that's 13 or 14 that might want to go there, no way, that's so embarrassing to be asked really intrusive questions in a not very nice way, I thought.

Do you remember some of the questions?

It wasn't lots of questions or anything, it was just 'what do you want to see them for', with 10 people behind you listening. And to say 'I want to go on the pill' or 'I want to use a condom' or 'to talk about contraception', probably if I was 13 and thinking about having sex, I wouldn't bother. That's what worried me, it wasn't for my sake, even, it's because I think that other people wouldn't bother, younger people.

In your opinion, how could these difficulties be improved?

It could be more private and the receptionists could be a bit nicer! I know that they're not nurses, you know it's not their job to particularly deal with you. But you know, they've got to know that Family Planning as opposed to a doctor is probably, some would think, a less embarrassing option and a more likely option for 13 or 14 year olds. But if it is embarrassing, it's quite possible for a 13 or 14 year old to walk out with nothing and just say 'oh well never mind, I won't get pregnant anyway, it's my first time'. That's the worst option, that's the worst possibility, I think.

People we talked to often preferred Family Planning or Brook clinics because of their 'walk in' system, handy opening hours, specialised knowledge, appointments available at short notice, and more time with staff who gave clear explanations and answers to questions. Some of the women we spoke to liked the fact that most clinics had mostly female staff, who they felt more comfortable with.

Full-time mother lives on her own with her ten-month-old daughter. She would like to continue studying and to work with children.

I was fifteen when I started going there and I was like 'oh what do I say, what do I ask for', and I just went there and they were a really friendly service and they were really kind, confident, friendly and they help you whatever your problems.

Okay, so you had no...

They give you all the options, there's like the pill and condoms and they give you leaflets and they give you a big pack of condoms as well and say while you're thinking about it, use these.

Did they explain things to you?

Yeah, they explain everything to you, they explain all these sort of ins and outs of the pill and the condom saying its not, sometimes it's not 100% and they say all of that.

I went down the Family Planning Clinic and they told me like everything. They were like, well they drummed it into your head that you are supposed to take it for twenty eight days, seven day break, twenty eight days, seven day break, and they said you can't miss a pill for more than three hours and if you do you can get emergency contraception. If you get diarrhoea or anything like that you are having side effects from the pill, if you get migraines you are having side effects from the pill. They told me everything.

view profile

Profile Info

Age at interview:

23

Sex:

Female

Background:

Holds a science degree and works full time. At time of interview she has been in a long-standing relationship for the past five years. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

Well I really didn't want to go and see my family doctor and I wanted to go somewhere that specialised in it and really knew what they were on about and I didn't want to run the risk of meeting someone I knew.

OK it seems that sort of you don't want your GP to be involved in sort of your decision regarding...

Well, not really, I mean I don't really know my GP that well, I've moved around quite a lot, I just found it quicker and easier to get an appointment at the family planning clinic and keep it away from the family doctor, kind of thing.

Well I didn't really mind as such, it's just that it's easier to get an appointment at the family planning clinic isn't it, it's quicker and easier.

Is your GP male or female?

I don't know really, I think it's female but I've moved around so much and had so many different GPs, I'm pretty sure she's a female' yeah I mean I'd go and see a lady doctor about it.

Sometimes there can be a long wait for the doctor in a walk-in clinic. In cities, staff in clinics can be under pressure. A young man described how he felt unsure the first time he went to a local family planning clinic.

Black Caribbean young woman who works full time in the administrative sector. Since starting her sexual life she has used contraception. Her primary concern has always been to avoid unwanted pregnancy. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

I think if I had any worries I'd probably go to my GP. For the simple fact that when you come here, there's a ridiculous wait to see the doctor. So, there's like a two-hour wait to see the doctor, so I think if I had concerns then I would rather go and see my GP, because then I know I've got an appointment, I won't wait that long. In and out in maybe twenty minutes.

Okay, when you came here you said the waiting time is ridiculous. How do you think they could improve it?

I think they should run an appointment system to be honest. If you miss your appointment you just have to rebook, I think.

But in some cases may stop people that just walk in.

Fair enough if it's an emergency, if you need emergency contraception, fair enough, that should be a walk-in one. But I think if you need to get more pills or condoms or you've got to have a smear or something, I think those should be appointments.

view profile

Profile Info

Age at interview:

21

Sex:

Female

Background:

Bangladeshi woman, mother of a two-year-old child. She and her partner had a religious ceremony and she works part-time for a children's organisation. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

Yeah, Family Planning Clinic, I mean your normal doctor's will give it to you when you go and see your doctor, when your time comes, or they give you a date when you next need your pills or need your next Depo done.

But when I went to the same doctor but it's across the hall and then I went to ask them if I could' 'I'm running late for my Depo so I need you to get it done so I don't end up getting pregnant.'

And then they asked me if I was registered. I went 'Yeah, across there.' They go 'Have you got anything wrong with you?' and I was like 'No, I've just come from the doctor's which is, you know you're linked to it.' 'Have you been to the family clinics before?' 'No I haven't because I didn't need to use it before,' you know.

They went in to check with the doctor's to ask if I was who I was saying I was. You know 'I'm just sitting there because I'm part of the doctors, I'm part of your doctors, I've just come to the Family Planning Clinic because the doctor's was shut.'

I think that was one of the reasons why it was off-putting for young people to go in to Family Planning Clinics, they ask too many things, they need to make the questionnaires not as long' or personal.

What kind of things did they ask you?

A little bit of family history, your sexual history so I think that's also kind of, to know what kind of things you describe your' Well, sometimes I think they don't need to know that, you know, they've come to you for a reason.

I think also 'cos they're over run and they've got so many people they don't really have time to sit down and say 'Oh you know you've got this;' 'we've got that, this will get you in'. Sometimes when I first started going to use clinics I got the feeling they couldn't be bothered with young people you know. Because either they don't have the time or it's the things like you know 'look it's another one who needs condoms'.

view profile

Profile Info

Age at interview:

22

Sex:

Male

Background:

Young father of a three-year-old son and a seven-month-old baby. He and his partner are not planning on having any more children. The first time he went to a Family Planning clinic he was sixteen.

Where did you learn about contraception?

It was really during school. Like when they had the sex education classes, where they show you like videos and stuff like that. And there's a Family Planning Clinic in [town] which... I was round about 16 when I first went down there and that and they give you like free condoms, contraception and things like that. So I mean they would give you leaflets to read about it like, illnesses and all stuff like that.

And how did you know about family planning?

I heard about it off one of my mates, he was a couple of years older than me, like he said 'I've been going down here for a few years,' he said, 'they give you a few, like will last you a life time", but he went like where it is, if you know, were worried about anything or wanted any advice they're there to help you to get through it and stuff like that, 'cos he's had a few...

He didn't really go into detail but he's had a few experiences where he thought something was wrong, so that's how they helped him out and that's how he got me to go down there.

And when you went to the Family Planning Clinic, can you tell me, how was it?

It was very nervous first of all, 'cos he's talking to a complete stranger about like your very private life. But no it was, it was OK, but like they made you feel very at ease and they have a laugh and joke with you and...

And you saw a female or male doctor?

It was female actually.

OK.

Yeah. That did make it a bit like, at the time, but the bloke who, the mate who showed me the place and that, he said 'No she's a very lovely woman, any problems just speak to her about it and she'll tell you the best way, go and see your GP, or anything like that.'

What questions did you bring up in the interview?

It was just like when I walked in there like and I just waited for me appointment, and went in there and I said that 'I'm thinking about going further with a few like, with me girlfriend and that,' and they went 'Is she on the pill?' I said 'Yeah, she's on the pill, but I also want to use contraception meself.' So it went, it went on for nearly, it was just like a basic sort of things like what was it? It was a basic things like going in there like speaking to them and how like, they don't ask, they don't push you for the answer for questions and that, they like say 'Well is it, if you want to use it, what is it for?'

And it's like I said to them 'It's for me girlfriend it's so I don't have no mistakes or anything like that.' And it was just basically I went a couple of times after but then I met, and all that sort of thing, met me other half and we've gone on from there sort of.

It's possible to use different services for different needs, such as GPs for a smear test, Family Planning for contraceptives, and sexual health (or GUM) clinics for STI check ups. People we talked to who had used GUM clinics usually liked the 'easy going' attitude of the staff, but some people were concerned about confidentiality or found the personal questions embarrassing.

Recently graduated, works as a manual worker in a supermarket. As a gay man thinks that it is important to provide young people with a safe environment to learn about their sexuality.

Well, I feel very uncomfortable talking to my General Practitioner about this sort of thing, simply because my General Practitioner is a friend of my family and although he's s'posed to be you know, he's s'posed to be completely confidential etc. I've never felt particularly comfortable telling him. I mean I've, as I said before I've used the clinic, the STI clinic once when I felt specifically that I was might have been presenting myself at some risk.

I found it to be an unwelcoming experience and something that I definitely wouldn't have gone through with on my own, had I not had an adult there with me, I think I would have found it very traumatic. I wouldn't say I found the staff particularly helpful but there was a counsellor there who did discuss things with me and she was very friendly.

Why didn't you find them particularly helpful?

Well I mean not helpful, but they were very matter of fact which is fine, but I can imagine some people finding that incredibly difficult to deal with. Because of embarrassing and things like that and they were asking all these detailed questions etc, and to be fair if you got, if you've come to that situation, if you turned up at the clinic they shouldn't have to ask you all these questions. They should sort of, I think they should test you for everything and sort of give you advice, but not sort of...

They ask you detailed questions about your own sexual life?

Yes, which which for some people might put them off doing it again, you know. I think it's a situation which is, I think the one thing that majorly put me off was the fact that you have to book in advance where I was before, you have to make an appointment and when you turn up your appointment is not kept to the time, its after the appointment time and therefore you sit around for 3,4,5 hours waiting for it, which is enough to put you off doing it, I found that to be pretty bad where I was.

I also found that I missed one of my appointments in fact and although I was told that my details would be kept on file only for records. When I started receiving cards through the post saying I'm incredibly concerned that you didn't turn up for your appointment and things like that saying what my appointment was for, I felt that they crossed the line of patient confidentiality in the sense that someone else could have opened my mail.

I mean you can often have the situation when people have the same surname and the same first initial or something, and therefore someone else could have opened it and read the card or whatever.

Several people we talked to had attended sexual health youth projects in their neighbourhoods. These projects provide services such as counselling, advice and information and free condoms, and were sometimes seen as more informal and friendly than a hospital.

Young gay man who works as a volunteer in a youth group project in the inner city. He plans to go to University and continue his studies.

I've wanted to have a test for a while, but I've always been scared of going into hospitals and I don't really like hospitals and the whole thought of going into a hospital scares me.

But there's an organisation in [city] that I went to that has a clinic on a Monday night, so I went there and it's a nice environment, safe, colourful and it doesn't feel, it's not a hospital so, you know, they have a clinic downstairs and it felt comfortable there. So..

So it was sort of embarrassment or...?

I was embarrassed, very, yeah. I went there and they ask you awkward questions like about your sex life and you know, how many partners you've had and stuff like that and it was a bit embarrassing, so like you know, asking questions, especially when there's two people in the room with you. So I was a bit, a bit nervous and scared. But it was OK, they made me feel welcome and safe and I felt OK.

And how was the experience of having the tests done?

Scary. I'm still a bit nervous.

Can you describe to me sort of what it is like, for the website?

Yeah. What they did is they took me into the clinic area, asked me a few questions and personal details and partners I've had, if I've used protection, have I been tested before. And then they suggested what I'm, 'cos I'm a gay man, young gay man, what I should be tested for HIV, syphilis, 'cos there's an epidemic going around [city] at the moment of Syphilis and Hepatitis.

And they give you a blood test, HIV test and then they give you the vaccine, Hepatitis vaccine. And then in two weeks time I get my results and then I have another vaccine of Hepatitis, and then I have to go back in six months for my third one.

It's just that I wanted to make sure that I was safe, I've never been before and I've been sexually active since like '98 and it's like five years now and I've not been tested at all, so I thought it was about time that I was tested. Just to be on the, to make sure for myself, 'cos I've had a few partners, and casual partners.

People we spoke to said sexual health services need to be better advertised, that there are lots of young men and women 'out there' who don't know what is available and how to access it. They said it was equally important for young people to know that they have a right to confidentiality.